Fear after an accident or after a sudden and severe attack of a somatic disease is a clear psychological crisis.
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As in other emergency situations, the life of a person transported urgently to a hospital is always in shock, and it may be aggravated by the possible callousness of people in the ambulance. When the patient arrives at the emergency department, there is an atmosphere of incredible hurry, because everyone realizes that every minute is very important.
The employees of the emergency department have neither the time nor the way to reflect on the emotional needs of the patient. The victim or severely ill patient must be quickly examined to assess the type of injury or the risk of the disease and what must be done immediately to compensate for the threat to life. Until the arrival, the patient may not display one or many life activities. Assessing the situation and trying to restore vital functions are in themselves a sufficient task.
Doctors and nurses in emergency departments skillfully and frantically fight to save their lives, so the patient's psychological and spiritual needs are not a priority for them.
A seriously ill or injured patient, often in a state of emotional or physical shock, usually does not even know what is happening to him.
Sometimes, however, the patient may be conscious enough to see how serious his situation is. The victim of an accident, probably with the howl of sirens and flashing lights in the memory and the dark world of unknown figures gathered above her, can be overwhelmed by fear for her present and future security. Patients may feel alienated in new conditions, and bustling staff may be perceived as the caretaker of this seclusion, after which nothing good can be expected.
Accident victims should behave according to the following rules:
1.) The victim of the accident should be informed who we are, what actions we take towards her and where she is taken. This information should be honest.
2.) The patient should be informed (not necessarily with details) of how serious her condition is. However, there are cases when the patient completely denies our statements, downplays them or even reacts to information with aggression.
3.) In the accident department or still in the emergency room, try to familiarize the patient with the surroundings. The patient may be conscious but confused, especially if he has a head injury. Let's try to talk to him in a succinct, concrete and understandable way.
4.) If you provide information to the patient about the possible death of a family member, passenger, victims or other persons involved in the accident, be gentle. If the patient is in a critical condition, wait before telling him that his wife is dead.
5.) If urgent surgery is needed, inform the patient if he is conscious and aware. The conversation about the necessary surgery should be carried out, being alone with the patient. If he is unconscious, inform the family and ask for permission.
6. A hospital employee - a nurse, clergyman, social worker or a specially trained volunteer - should sit with a patient in a small room and let him talk about an accident.
(J. Krzyżowski: Terminal disease, accident victims and dying, in: Emergencies in psychiatry, Medic 2008.)
Doctor of Medicine Janusz Krzyżowski
Psychiatrist
Private office tel. 22 833 18 68
00-774Warszawa, Dolna 4 lok. 15
